Lecture 5: Dimensional Taxonomy

Question 1

What is essentialisms

Answer 1

Psychiatry is rooted within the medical discipline and accordingly understands psychopathology as a structural, (epi)genetic, cellular, molecular or other underlying disturbance that is located inside the body/brain

Question 2

What are the 3 core ideas

Answer 2

1. An underlying cause explains the occurrence of all symptoms of a cluster of symptoms
2. Mental disorders are defined by a set of symptoms that are caused by essences
3. Clusters of symptoms are independent from each other because they have a different cause

Question 3

What are 4 issues with having separate syndromes

Answer 3

1. Arbitrary cut-offs; no boundary in nature for these kinds of things
2. Heterogeneity
3. Co-occurrence/comorbidity; problematic because comorbid cases are usually not included in research and people don’t usually think like this
4. Continuity of personality and psychopathology

Question 4

What are 4 alternative forms of innovative models

Answer 4

1. Dimensional trait models; grounded in empirical data, think in continua about psychopathology
2. Network approach
3. Transdiagnostic approach; broad factors that are understood to play a key role in many mental disorders
4. Personalized approach; person and their context should be focus of clinical care

Question 5

What are the 5 principles of network theory (approach)

Answer 5

1. Mental disorders are problems of living; disease mechanism doesn’t exist
2. Mental symptoms are not the effect of a common cause but the result of (bi)directional causal connections between symptoms
3. Syndromes exist and are a cluster of causally connected symptoms which forms a new (disordered) homeostasis
4. Hysteresis = although the trigger for activation of the network is gone, the network becomes self-sustaining and gets stuck in active state
5. Symptom-component correspondence = network theory has no discrete categories/latent markers, this means that they’ve found common network structures of symptoms that more or less align with categories in diagnostic manuals

Question 6

What are the 4 steps to how we got to HiTOP

Answer 6

1. Dimensionalizing a syndrome
2. Factor analyzing multiple syndromes
3. Factor analyzing large sets of symptoms
4. Joint factor analysis of personality and problems

Question 7

Personal recovery (5)

Answer 7

• inter subjective understanding
• collaboration
• first person perspective
• promote personal recovery
• hope, meaning, identity

Question 8

DSM (4)

Answer 8

• continuity with research tradition
• communication with society
• status as a medical profession
• reimbursement

Question 9

HiTOP (3)

Answer 9

• empirically grounded taxonomy
• more adequate representation of dimensionality and heterogeneity
• continuity with epidemiological research

Question 10

Case conceptualization (5)

Answer 10

• explanatory hypotheses
• applying psychological theory
• using clinical expertise
• developing a treatment rationale
• learn clinical reasoning

Question 11

What are 3 aspects of the personalized approach and explain them

Answer 11

1. Precision psychiatry; technologies/treatments are not developed for individual patients but a high level of exactness in measurement will lead to personalization eventually
2. Personalized psychiatry; each patient is unique and therefore its clinically useful to focus on unique (lack of) homeostasis within individuals; shift from syndromes focus to symptom focus/group to individual focus
3. Person-centered psychiatry; whole person and their context and need should be the focus of clinical care